Download Surgical study guides for Preoperative Phase of Nursing

NUR 1021
STUDY GUIDE TOPIC
SURGICAL NURSING—PREOPERATIVE PHASE
A.
Objectives:
1. State how each of the following will help or hinder a patient’s ability to withstand anesthesia
and surgical trauma: age, weight, respiratory function, cardiac function, kidney and hepatic
function.
2. Describe activities to prepare the patient for surgery the evening before and the morning of
surgery.
3. Identify abnormal laboratory reports which might prevent surgery.
4. Describe how to teach postoperative exercises such as coughing and deep breathing,
incentive spirometer use, turning, and leg exercises.
5. Identify medications usually administered preoperatively and nursing actions to take with
each.
6. State the benefits of helping the preoperative client cope emotionally with the impending
surgery.
7. Discuss how the nurse can assist the client to meet emotional needs prior to surgery.
B.
Required Readings:
Hinkle and Cheever. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing.
Chapter 17, pp. 402-419.
Taylor. Fundamentals of Nursing.
Chapter 29, pp. 852-871; 884-889 (skill 29 – 1
NUR 1021 Spr Pack Surgical/
ASSESSMENT TOOL FOR PREOPERATIVE ANXIETY
Subjective Data
1.
2.
3.
4.
5.
6.
7.
8.
Understanding of proposed surgery
a.
Site
b. Type of surgery to be done
c.
Information from surgeon regarding extent of hospitalization, postoperative limitations
d. Preoperative routines
e.
Postoperative routines
f.
Tests
Previous surgical experiences
a.
Type, nature, time interval
Any specific concerns or feelings about present surgery
Religion
a.
Meaning for patient
Significant others
a.
Geographic distance
b. Perception as source of support
Changes in sleep patterns
Anxiety level
a.
Mild
b. Moderate
c.
Severe
d. Panic
Readiness to learn and retain information
Objective Data
1.
2.
3.
Speech patterns
a.
Repetition of themes
b. Change of topic
c.
Avoidance of topics related to feelings
Degree of interaction with others
Physical
a.
Pulse and respiratory rates
b. Hand movements and perspiration
c.
Activity level
d. Voiding frequency
After completing the above assessment, what is the nurse's greatest responsibility to the pre-op
patient?
State several reasons for patients not verbalizing pre-op fears.
NUR 1021 Spr Pack Surgical/
MARION TECHNICAL COLLEGE
NURSING EDUCATION DEPARTMENT
THE OPERATING ROOM EXPERIENCE
THE ROLE OF THE OPERATING ROOM TEAM
Surgery is a complex field requiring a coordinated team effort. Three objectives of surgical
patient care are listed below:
1.
2.
3.
The delivery of a psychologically and physiologically prepared patient to surgery.
The safe, efficient, and sound alleviation of the patient's problem.
The careful guidance of the patient's immediate postoperative course.
These objectives are partially fulfilled in the clinical unit preoperatively and in the recovery
room postoperatively. But it is in the operating room itself that the operative team must
fully coordinate its work if the surgery is to have a successful outcome.
As the student first approaches the operating room, he or she should strive to form a
general picture of the operative team. This picture should define the duties of each member
of the team and depict these members in actual function as they carry out their duties.
Such an overall concept will aid the student immensely when she later assumes the role of
scrub nurse or circulating nurse.
ROLE OF THE ANESTHESIOLOGIST AND ANESTHETIST
The general well-being of the patient is the responsibility of the anesthesiologist and
anesthetist. By relieving the surgeon of this responsibility they permit him to concentrate
on technical aspects of the operation.
In addition to their general responsibilities of evaluating the patient preoperatively,
anesthetizing the patient, and keeping him at adequate but safe levels for surgery, the
anesthesiologist and anesthetist:
1.
2.
3.
4.
Infuse whatever drugs are required by them or the surgeon.
Transfuse blood or blood products as necessary.
Alert the surgeon to any impending difficulties and treat these as they arise.
Supervise the recovery room management of the patient.
ROLE OF THE CIRCULATING NURSE
The more experienced or senior nurse usually assumes the role of circulating nurse. As the
only nonscrubbed member of the surgical team, the circulating nurse represents the
connecting link between the scrub team and all other departments that may be called upon
to assist the surgeon. This nurse is instructor, supervisor, and manager in the assigned
operating room.
A list of some of the general duties of the circulating nurse will assist the student to
appreciate the importance and versatility of this member of the surgical team.
Duties Relating to the Operating Room
1.
2.
Checks the room for general cleanliness and orderliness prior to each case.
Checks operating room lights, suction and oxygen machines, and other pieces of
3.
4.
5.
equipment, making certain they are all available and properly functioning.
Adjusts lights, stands, stools, and other equipment as it is used in each case.
Checks proper functioning of sterilizer.
Rearranges and supervises the preparation of the room after each case in anticipation
of the following case.
Duties Relating Directly to the Patient
1.
2.
3.
Receives and identifies patient from the receiving area.
Introduces self to the patient and attempts to develop rapport and confidence.
Reviews preoperative check list to be certain it is complete and sees that the procedures
have been accomplished.
4. Checks for any available x-rays and brings them to the operating room.
5. Makes certain that blood has been typed and cross-matched.
6. Aids in transferring patient to operating room table.
7. Positions and secures patient on table and confirms position with surgeon.
8. Covers patient's hair with a cap.
9. Rearranges draw sheets, cover sheets, and anesthesia screen to be certain nothing will
interfere with the operation.
10. Initiates skin prep according to routine of hospital and surgeon. This is done after the
patient has been anesthetized.
Duties Relating to Operating Room Personnel
1.
2.
Helps to gown all members of the scrub team.
Keeps a constant vigilance on proper dress, movements, and techniques of all
personnel to insure no break in aseptic technique.
3. Checks to be certain scrub nurse has everything needed to begin the operation.
4. Is available to the scrub nurse for advice and for obtaining any special equipment
deemed necessary as the case proceeds.
5. Checks with the surgeon concerning any special equipment or suture material that may
be required.
6. Supervises and aids in sponge, needle, and instrument counts.
7. Calls x-ray or laboratory technicians at the surgeon's request.
8. Calls pathologist at the surgeon's request.
9. Keeps room as clean and orderly as possible during the case.
10. Is available to the anesthesia team for obtaining special drugs, aiding with initiation of
intravenous fluids, and so forth.
11. Accepts, labels, and records all specimens received from the surgeon.
12. At conclusion of case, assists in transferring patient to litter for trip to recovery room.
ROLE OF THE SCRUB NURSE
Becoming an efficient scrub nurse requires, above all else, experience. This must be
intelligent experience, based on a thorough understanding of each proposed surgical
procedure and a careful observation and anticipation of each step in the operation.
Thorough Understanding of the Procedure
The scrub nurse must:
1.
2.
Read the schedule, noting type of case, estimated length, and type of anesthesia to be
used.
Review basic anatomy, physiology, and operative technique books if not already
thoroughly familiar with that type of case.
3.
4.
5.
Check all types of instruments to be used in the case. Determination of any special
instruments should be discussed with the surgeon prior to the surgery.
Discuss any questions about the nature of the case with the surgeon.
Have available all the types of sutures that will probably be used in the case and
determine any preferences the surgeon may have.
Observation and Anticipation of Each Step in the Procedure
The scrub nurse must:
1.
2.
3.
4.
5.
6.
Observe the skin incision for bleeding to anticipate the need for hemostatic clamps and
ligatures to control the bleeding.
Observe the progress of the dissection and isolation of tissues in order to anticipate the
need for special retractors, sponges, abdominal packs, and the like.
Observe the surgical field to keep it free from all unnecessary instruments, sponges,
and free suture ends. Neatness is a major factor in safe, efficient surgery.
Anticipate special problems. An example is a ruptured appendix in which special
equipment will be needed, and the circulating nurse will be advised in a timely manner.
Observe all members of the operating team for possible breaks in aseptic technique and
to announce such breaks should they occur.
Watch the surgeon's hand signals carefully to determine which instruments are needed.
Review:
The scrub nurse's duties are manifold and include:
1.
2.
3.
4.
5.
6.
Aiding the surgeon and assistants in gowning and gloving.
Aiding the surgeon or assistant in draping the patient.
Handing instruments, sponges, sutures, and so forth to the surgeon and assistant as
needed.
Holding retractors, if necessary.
Aiding in the sponge, needle, and instrument counts.
Observing the team for breaks in aseptic technique.
ROLE OF THE SURGEON AND ASSISTANT
The surgeon performs the operation with the help of an assistant. The assistant is
responsible for exposing the operative site for the surgeon. This requires retraction of
nearby tissues away from the operative site, and sponging or suctioning of blood and serum
as it accumulates and obscures the local anatomy. Should small venous or arterial
bleeders be found in the operative site, often it is the assistant who grasps them with
hemostats preparatory to ligating them with suture. Either the surgeon or assistant will
ligate these "bleeders."
It is important that the scrub nurse understand the various functions of the surgeon and
the assistant or assistants in order to better anticipate which instruments each is likely to
request.
Increasing Your Learning
If you are to obtain maximal benefit from your operating room experiences, a proper
viewpoint is necessary. Too often the student nurse stands at a great distance from the
operating area so that it is impossible to observe the scrub team properly. Use a foot stand
and position yourself at the table, near the anesthesiologist. This will keep you outside the
sterile field and yet close enough to observe the procedure.
This manual should guide you as to the surgical procedure being done. Be certain you
have reviewed the steps of the procedure carefully before the surgery begins. With proper
preparation you will be in a position to ask appropriate questions of the surgeon.
During this observation:
A. Observe the scrub nurse carefully. Note:
1.
2.
3.
4.
5.
6.
7.
8.
Arrangement of instruments and sutures on the Mayo stand.
How instruments are handed to the surgeon.
How the operative field is continually cleaned of old sponges and suture ends.
Arrangement of instruments and basins on the reserve table.
How the surgeon is assisted with gowning and gloving.
Arranging of drapes and suction.
How instruments are cleaned when received back from the surgeon.
The interaction between the scrub nurse and the circulating nurse.
B. Observe the circulating nurse carefully. Note:
1. How patients are transferred to the operating table, positioned and strapped in place.
2. How the operating table is adjusted and drapes rearranged to provide optimum
exposure of the surgical site.
3. The skin prepping procedure.
4. How the surgeon is assisted with gowning/gloving and how the surgical lights are
adjusted.
5. Observation of and instructions to the scrub nurse.
6. How the room is kept tidy.
C. Observe the anesthesiologist. Note:
1. Induction of anesthesia.
2. Method of giving spinal and/or other types of anesthesia.
D. Observe the surgeon and assistants. Note:
1. Progress of surgery.
2. Hand signals for instruments and sutures.
3. Use of instruments in sequence.
E. Observe the patient. Note:
1. Positioning and use of pillows or other devices to assist circulation.
2. Application of the “Bovie” pad.
3. How and when patient is awakened.
NUR 1021 Study Guide Sect Surgical Nursing/